Journal Article

HIV drug resistance in persons who inject drugs enrolled in an HIV prevention trial in Indonesia, Ukraine, and Vietnam: HPTN 074

Guo, Xu, Hoa, Ngo T. K., Eshleman, Susan H., Zhang, Yinfeng, Piwowar-Manning, Estelle, Richardson, Paul, Dumchev, Kostyantyn, Anandari, Latifah, Hanscom, Brett, Hamilton, Erica L., Fogel, Jessica M., Liulchuk, Mariya, Djoerban, Zubairi, Ha, Tran Viet, Miller, William C., Hart, Stephen, Breaud, Autumn, Clarke, William, Palumbo, Philip J., Hoffman, Irving

2019

Overview

Persons who inject drugs (PWID) have high HIV incidence and prevalence, and may have limited access to antiretroviral therapy (ART) in some settings. We evaluated HIV drug resistance in PWID in a randomized clinical trial (HPTN 074). The study intervention included ART at any CD4 cell count with enhanced support for ART and substance use treatment. HPTN 074 enrolled HIV-infected PWID (index participants) with viral loads ≥1,000 copies/mL and their HIV-uninfected injection-network partners in Indonesia, Ukraine, and Vietnam; the study limited enrollment of people who reported being on ART. HIV drug resistance testing and antiretroviral (ARV) drug testing were performed using samples collected from index participants at study enrollment. Fifty-four (12.0%) of 449 participants had HIV drug resistance; 29 (53.7%) of the 54 participants had multi-class resistance. Prevalence of resistance varied by study site and was associated with self-report of prior or current ART, detection of ARV drugs, and a history of incarceration. Resistance was detected in 10 (5.6%) of 177 newly diagnosed participants. Participants with resistance at enrollment were less likely to be virally suppressed after 52 weeks of follow-up, independent of study arm. In HPTN 074, many of the enrolled index participants had HIV drug resistance and more than half of those had multi-class resistance. Some newly-diagnosed participants had resistance, suggesting that they may have been infected with drug-resistant HIV strains. Behavioral and geographic factors were associated with baseline resistance. Baseline resistance was associated with reduced viral suppression during study follow-up. These findings indicate the need for enhanced HIV care in this high-risk population to achieve sustained viral suppression on ART.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Analysis / Anti-HIV Agents - pharmacology / Anti-HIV Agents - therapeutic use / Antimicrobial agents / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Biology and Life Sciences / Care and treatment / CD4 antigen / Clinical trials / Disease prevention / Disease transmission / Drug resistance / Drug Resistance, Viral / Drug therapy / Drug use / Drug Users - statistics & numerical data / Drugs / Epidemiology / Female / Geography / Health risks / Highly active antiretroviral therapy / HIV / HIV infections / HIV Infections - epidemiology / HIV Infections - prevention & control / HIV Infections - virology / Human immunodeficiency virus / Humans / Indonesia / Infectious diseases / Injections - statistics & numerical data / Male / Mediation / Medical research / Medicine / Medicine and Health Sciences / Microbial drug resistance / Middle Aged / Mutation / Needle Sharing - statistics & numerical data / Pathology / Prevention / Public health / Risk factors / Sexually transmitted disease prevention / Substance abuse / Substance use / Trends / Ukraine / Vietnam / Viral Load - drug effects